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Psychotherapy for Bipolar Disorder


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Bipolar Disorder being a Bio-Chemical condition, is primarily treated with medication. Along with medication, Psychotherapy can help in recovery. Choose your Psychotherapist after a proper screening process. A Psychotherapist's role is also to ensure adherence and to spot early symptoms of mood swings.

Published in: Health & Medicine
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Psychotherapy for Bipolar Disorder

  1. 1. PSYCHOTHERAPY FOR BIPOLAR DISORDER Hvovi Bhagwagar Psychotherapist, Manashni WORLD BIPOLAR DAY 2018 1
  2. 2. Mood Disorders 4/9/2018Hvovi Bhagwagar, APR2018 2
  3. 3. Bipolar is a Bio- Chemical Condition Psychotherapy is not the first line of treatment 4/9/2018 Hvovi Bhagwagar, APR2018 3 Strongest support- Lithium (1949)– recommended by APA Practice Guidelines
  4. 4. Pharmacotherapy • Mood Stabilisers and Anticonvulsants typically given • Combined with Anti Psychotics and Benzos • Anti-depressants given with caution • Blood tests to be done regularly • During manic phases risk of non-adherence increases. • Psychotherapy is adjunct to pharmacotherapy • Know about medications! 4/9/2018 Hvovi Bhagwagar, APR2018 4
  5. 5. What questions should I ask my doctor? • What are the side effects and risks of the medication you are recommending? • When and how should I take this medication? • Are there any foods or other substances I will need to avoid? • How will this drug interact with my other prescriptions? • How long will I have to take this medication? • Will withdrawing from the drug be difficult if I decide to stop? • Will my symptoms return when I stop taking the medication?
  6. 6. How often should I talk with my doctor? During acute mania or depression -Once a week minimum to monitor symptoms, medication doses, and side effects. -After the acute phase has been managed visits will be once a month to once in 3 months. During an emergency: -Suicidal or violent feelings -Changes in mood, sleep, or energy -Changes in medication side effects -An acute medical illness or need for surgery, extensive dental care, or changes in other medicines you take -A change in your medication situation, such as pregnancy Source: Treatment of Bipolar Disorder: A Guide for Patients and Families 4/9/2018 Hvovi Bhagwagar, APR2018 6
  7. 7. Take medication responsibly Use a daily reminder/medication saver system Throw away old medications or those you are no longer taking. Medications work best when you are making other healthy choices. Don’t expect a pill to fix a bad diet, lack of exercise, or an abusive or chaotic lifestyle. Reduce or discontinue the use of alcohol. Alcohol is a depressant and makes recovery even more difficult. It can also interfere with the way your medication works. Source: Depression and Bipolar Support Alliance
  8. 8. Links of interest in medication management 1. Overview of common medications, including mood stabilizers, antipsychotics, and antidepressants. (NAMI) 2. Covers the negative effects of antidepressant medication on the course of bipolar disorder, and new drug options for the depressive phase. disorder 3. Information on Lithium 4. Learn about generic and brand name drugs for bipolar disorder and how to make smart medication choices.
  10. 10. 10 • Visit a trained psychologist or psycho-therapist who has experience with mental health issues, not a “counsellor” • Request for credentials- reputed university, training in researched therapies such as CBT, REBT, EMDR • Ask them for psycho-education about your condition (if they know less than you, please shift) • Choose between two experienced therapists based on “good-fit” How to select a trained mental health practitioner
  11. 11. Types of Psychotherapy •Cognitive Behavioral Approaches (CBT/REBT) •Brief Solution Focused Therapy •EMDR- Eye Movement Desensitization and Reprocessing •Psycho-analysis 11
  12. 12. What does Psychotherapy do? Teaches the benefit of remaining calm or at least neutral when faced with difficult situations. If you are upset by your problems, you now have 2 problems: 1) The problem 2) Your upsetness. 4/9/2018 Hvovi Bhagwagar, APR2018 12
  13. 13. What does a trained therapist do? 1. Assessment • Extensive history-timelines of the episodes. • Psycho-diagnostic evaluation (to rule out comorbidity) • Monitor psychiatric intervention • Recommend other Medical interventions if needed 4/9/2018 Hvovi Bhagwagar, APR2018 13
  14. 14. 2. Psycho-education • Explain the disorder o BD runs in families o “Bio-psycho-social model” o The Depression Negative triad • Explain Brain Physiology • BD needs to be treated with both medication and psychotherapy • Family education/therapy 4/9/2018 Hvovi Bhagwagar, APR2018 14 What does a trained therapist do?
  15. 15. 3. Treatment • Regulate daily schedule • Restructuring Negative thinking • Promote adherence with medication regimens • Reduce risk of suicide • Identify triggers that increase the risk for relapse 15 What does a trained therapist do?
  16. 16. Day 1 Day 2 Day 3 Day 4 6-7 am 7-8 Morning routine A = 2, p = 0 8-9 Drive to work A = 3, p = 3 9-10 Finish document A =5, p = 4 10-11 Therapy A =5, p = 4 11-12 Noon Sit outside A =2, p = 4 12-1 pm Lunch A = 1, p = 3 1-2 Staff meeting A =4, p = 3 Example of Activity Schedule… 4/9/2018 Hvovi Bhagwagar, APR2018 16
  17. 17. 2-3 3-4 Write letters A =3, p = 3 4-5 Conference call A = 3, p = 2 6-7 Dinner A = 2, p = 2 7-8 T.v. A =2, p =2 8-9 TV 9-10 TV 10-11 TV 11-12 mid Sleep ….Activity Schedule Contd Conclusions Watching too much T.V. * No physical exercise * Much less time with friends than before * Few pleasurable activities 17
  18. 18. Managing Negative thinking 4/9/2018 18
  19. 19. Situation Automatic thought(s) Emotion/ Body Sensation Alternative response Outcome Repriman ded by boss for not meeting targets Felt I had done much less than required My luck has come to an end, they will fire me. All women are bad bosses Angry 90% Anxiety 90% Body rigidity, craving for coffee and non-veg food • Disqualifying the positive • Fortune teller • Generalising Whats the worst? Shifting me to another job role- I can handle that Don’t make it personal: the requirement is tough. Perspective: Client pressure is making boss agitated and critical. Anger 30% or less Anxiety 20% 19 Example of Restructuring Negative thinking
  20. 20. What can YOU do for yourself? 4/9/2018 Hvovi Bhagwagar, World Bipolar Day 2017 20
  21. 21. Self-help for depression • Maintain a routine as much as possible • Avoid disrupting biological rhythms (sleep, eating) • Keep thought logs and mood diaries which identify triggers • Increase pleasurable activities • Reflect on negative thoughts, make effort to think rationally 4/9/2018 Hvovi Bhagwagar, APR2018 21
  22. 22. Managing Hypomanic/Manic Episodes 4/9/2018 Hvovi Bhagwagar, APR2018 22 • Recognize warning signs-don’t be in denial • Interventions and Rules  Medical solutions first  Two-person feedback rule for “great ideas”  Limit cash payments • To counteract impulsivity:  Give car keys or credit cards to someone to keep  Rules about staying out late or giving out phone #  Avoid Substance use  Minimize stimulation  48-hours before acting rule
  23. 23. • Identify what worsens the manic episode (certain drugs, substances like coffee or alcohol) • Maintain structure and be disciplined • Sleep! Even if it means an extra dose of medication • Aerobic exercise too stimulating- try yoga • Keep thought logs and mood diaries which identify triggers 4/9/2018 Hvovi Bhagwagar, APR2018 23 Managing Hypomanic/Manic Symptoms
  24. 24. Prodrome= “running before”. The period that precedes a mood episode is known as the “prodromal phase.” How do you detect prodromes? Know about Bipolar Be a detective-analyse previous mood episodes “Check-in” with yourself daily-mood charts Is it characteristic of you? Employ another set of eyes Don’t be paranoid, just alert and cautious 4/9/2018 Hvovi Bhagwagar, APR2018 24 Spotting Icebergs From Miles Away: Carrie Elizabeth Lin Prodrome detection-Using Early Warning Signs In Bipolar Disorder Relapse Prevention
  25. 25. Sample Log: 1. What were the most severe symptoms or behaviors that ultimately led to the end result (e.g., suicide attempt, suicidal thoughts or feelings, psychosis, hopelessness)? 2. What was the approximate date when the episode was at its most severe? ____________ 3. What symptoms or behaviors do you recall before things got to their worst, but when you were almost “past the point of no return”? 4. What are the earliest warning signs you can remember? 5. What was going on in your life that might have triggered or made you vulnerable to the mood episode (e.g., stress at work, relationship problems, lack of social connection, financial problems, other health problems, alcohol or drug use)? 6. What was the approximate date the triggers or vulnerabilities started? Identifying Early Warning Signs From Prior Bipolar Disorder Mood Episodes 4/9/2018 Hvovi Bhagwagar, APR2018 25
  26. 26. Self Help books 4/9/2018 Hvovi Bhagwagar, APR2018 26
  27. 27. Mobile Apps 4/9/2018 Hvovi Bhagwagar, APR2018 27 Thought Diary
  28. 28. 4/9/2018 Hvovi Bhagwagar, APR2018 28
  29. 29. Finally I end with a quote from the guru himself…. 4/9/2018 Hvovi Bhagwagar, World Bipolar Day 2017 29
  30. 30. 30 H’vovi Bhagwagar 9821321132